SAN FRANCISCO — It will be impossible to eliminate hepatitis C in
Rhode Island in the next 15 years if Medicaid restrictions on treatment
coverage remain, according to the latest projections.
The state Medicaid program currently restricts the coverage of hepatitis C medications to patients with a fibrosis stage of at least 3.
"We need to ramp up screening and treatment if we really want to eliminate hepatitis C," Ayorinde Soipe, MBBS, from Brown University in Providence, Rhode Island, told Medscape Medical News.
Dr Soipe presented findings from a study of the projected prevalence of hepatitis C here at the International Conference on Viral Hepatitis 2016.
For most patients, the hepatitis C virus can be effectively cleared with the new direct-acting antiviral drugs. In the United States, however, many infected people can't afford to buy their own drugs; instead, they rely on Medicaid for coverage.
But Rhode Island and many other states have imposed restrictions on coverage for hepatitis C therapies. In addition to fibrosis scores, some limit coverage to people who are not using alcohol or injecting drugs.
Denying Claims
A recent survey conducted in four mid-Atlantic states showed that Medicaid programs denied nearly half the claims for direct-acting antiviral drugs, as reported by Medscape Medical News. By comparison, Medicare denied only 5% of such claims.
Policymakers have justified the restrictions by saying that states can't afford to pay for the new drugs for all Medicaid patients with hepatitis C, so they have targeted the sickest patients and those who are not abusing substances.
Dr Soipe and his colleagues wanted to see what effect various restrictions would have on the prevalence of infections and complications in Rhode Island.
They developed a statistical model similar to one created to project trends in hepatitis C nationwide (Hepatology. 2013;57:2164-2170), but adapted it to specific conditions in Rhode Island. They then made four projections.
Their first model looked at the prevalence of hepatitis C in 2030 under the current Medicaid policy, which covers an estimated 120 patients annually with fibrosis of at least stage 3. They projected that the number of people infected will gradually decline out to 2030; however, rates of complications, such as cirrhosis, will continue to be high.
Cirrhosis, Liver-Related Deaths
Their second model looked at the prevalence of hepatitis C if Medicaid coverage was expanded to 360 patients annually with fibrosis of at least stage 2. They projected that by 2030 there would be a reduction in viremic infection of 20%, a reduction in cirrhosis of 25%, and a reduction in liver-related deaths of 23%.
The third model looked at the prevalence of hepatitis C if there were no limitations on the stage of fibrosis — the joint recommendation of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America — and 360 patients were treated annually. They projected that by 2030, as in the second model, there would be a reduction in viremic infection of 20%. However, there would only be a 16% reduction in cirrhosis, and only a 14% reduction in liver-related deaths.
The state Medicaid program currently restricts the coverage of hepatitis C medications to patients with a fibrosis stage of at least 3.
"We need to ramp up screening and treatment if we really want to eliminate hepatitis C," Ayorinde Soipe, MBBS, from Brown University in Providence, Rhode Island, told Medscape Medical News.
Dr Soipe presented findings from a study of the projected prevalence of hepatitis C here at the International Conference on Viral Hepatitis 2016.
For most patients, the hepatitis C virus can be effectively cleared with the new direct-acting antiviral drugs. In the United States, however, many infected people can't afford to buy their own drugs; instead, they rely on Medicaid for coverage.
But Rhode Island and many other states have imposed restrictions on coverage for hepatitis C therapies. In addition to fibrosis scores, some limit coverage to people who are not using alcohol or injecting drugs.
Denying Claims
A recent survey conducted in four mid-Atlantic states showed that Medicaid programs denied nearly half the claims for direct-acting antiviral drugs, as reported by Medscape Medical News. By comparison, Medicare denied only 5% of such claims.
Policymakers have justified the restrictions by saying that states can't afford to pay for the new drugs for all Medicaid patients with hepatitis C, so they have targeted the sickest patients and those who are not abusing substances.
Dr Soipe and his colleagues wanted to see what effect various restrictions would have on the prevalence of infections and complications in Rhode Island.
They developed a statistical model similar to one created to project trends in hepatitis C nationwide (Hepatology. 2013;57:2164-2170), but adapted it to specific conditions in Rhode Island. They then made four projections.
Their first model looked at the prevalence of hepatitis C in 2030 under the current Medicaid policy, which covers an estimated 120 patients annually with fibrosis of at least stage 3. They projected that the number of people infected will gradually decline out to 2030; however, rates of complications, such as cirrhosis, will continue to be high.
Cirrhosis, Liver-Related Deaths
Their second model looked at the prevalence of hepatitis C if Medicaid coverage was expanded to 360 patients annually with fibrosis of at least stage 2. They projected that by 2030 there would be a reduction in viremic infection of 20%, a reduction in cirrhosis of 25%, and a reduction in liver-related deaths of 23%.
The third model looked at the prevalence of hepatitis C if there were no limitations on the stage of fibrosis — the joint recommendation of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America — and 360 patients were treated annually. They projected that by 2030, as in the second model, there would be a reduction in viremic infection of 20%. However, there would only be a 16% reduction in cirrhosis, and only a 14% reduction in liver-related deaths.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.